The tokophobia severity scale: a psychometric multicountry study with childbearing-age women

PURPOSE: Tokophobia refers to a clinically significant fear of childbirth that affects women across the reproductive lifespan. Given its prevalence and association with adverse mental health, obstetric, and reproductive decision-making outcomes, valid and reliable measures are essential to identify women at risk of tokophobia. METHODS: Tokophobia Severity Scale (TSS) psychometric properties were analyzed in nulliparous non-pregnant, pregnant, and women in the postpartum using data from cross-sectional and longitudinal studies conducted in four countries: Australia, Lithuania, Poland, and Portugal. Sample (n = 1,585) comprised nulliparous non-pregnant (Poland, n = 559), pregnant (Lithuania, n = 197, Portugal, n = 353), and women at two months postpartum (Australia, n = 292; Lithuania, n = 184). Participants completed the TSS, and self-reported questionnaires on sociodemographic, obstetric, fetal/neonatal, mental health-related characteristics, depressive and anxiety symptoms, birth trauma perception, and another measure of fear of childbirth (FOC). RESULTS: Results supported a three-factor model: fear, coping, and intrusive thoughts. Invariance was found across childbearing-age periods and countries. Cronbach's alpha and McDonald's omega coefficients for the TSS total score were 0.89-0.90. Known-group validity was established with differences in sociodemographic, obstetric, fetal/neonatal, and mental health-related characteristics. Concurrent validity was found with depressive and anxiety symptoms, and birth trauma perception. Convergent validity was found with another FOC measure. TSS scores in pregnancy predicted elective cesarean section, birth trauma perception, and postpartum depressive and anxiety symptoms. TSS discriminates women with or without clinically significant tokophobia symptoms in childbearing-age periods and countries. CONCLUSIONS: TSS is a psychometrically strong measure that can be used to screen clinically significant tokophobia symptoms.